First Person Account: Meaning of Psychoses

Schizophrenia Bulletin, Vol. 23, No. 3, 1997.

For most of my adult life I have existed in a condition considered by doctors to be a mental illness. This illness has been diagnosed as schizophrenia by a competent physician. Since over the years psychiatry has gone through different phases, there have been different theories about the origin of schizophrenia. Most currently adhere to the idea that most serious mental illnesses are brain disorders. It is not currently the fashion in the psychiatric community to search for the meaning of mental illness. The biochemical model of brain dysfunction dominates medical practice at this time, and medications are administered with great impact. With the aid of drugs some persons improve dramatically, but there are others who continue to deteriorate. I have found that, although psychiatric medication aids in the management of some of my symptoms, it only treats part of the problem.

I believe I have schizophrenia; I have a brain disorder. But along with this biochemical disorder is evidence of another problem. The search for the resolution of this problem has been a healing factor in my life. Not only has the result of this search been healing but the meaning found through the interpretation of the symptoms has also contributed to a restoration of the self. My search for meaning has shown me errors of interpretation made by others to be what they are—errors.

In this account, I first explain the conditions leading up to my psychotic episode. I describe this experience and other symptoms I’ve had. Then I discuss the significance of my search for meaning and how it has contributed to improvement in my condition.

During my childhood, I was accused of being too sensitive. In elementary school I would get upset fairly often and cry. Then, in junior high I became more friendly and outgoing. During this time I was a cheerleader and active in the student government, of which I was elected president. Starting in my freshman year of high school I was on the varsity tennis team. Then, in my sophomore year, I withdrew from the cheerleaders’ squad, not wanting to be in the spotlight. I became very introverted, read a lot of books, and wrote poetry and prose most of the time.I had few friends, and except for being on the tennis team, I withdrew socially. I had more crying spells, cut my wrists with razor blades, and overdosed on aspirin. My parents sent me to a psychiatric nurse for counseling. She and the consulting psychiatrist did not suspect schizophrenia at that time. The first summer after I graduated from high school I was asked if I would like to “work out” (practice) with certain tennis pros in California. I declined this offer and accepted the invitation to teach tennis instead. I only did this one summer and, soon after, joined a religious group.

The living conditions in this group were austere. I got very little sleep and put in long days of work. I fasted a few times, once for 7 days. I read the Bible or religious materials every day and prayed often. At one point, I meditated on a single religious phrase all day, repeating it over and over in my mind like a mantra. I had no friends inside the group or out, and I had almost no contact with my family. I lived in a state of poverty and had few possessions. The nutritional value of my food at this time was questionable, and there was not much of it.

After about a year of living with this group, I began to have hallucinations. At first, I thought they were spirits; I thought I heard angels and, later, demons. Upon their arrival I felt no surprise; it seemed natural to me. I was not shocked, but was in awe. What sounded like baby angels was soothing; they sounded sweet and loving. They comforted me. But the demons were chilling, and I was terrified. Sometimes I had to go to bed with the light on I was so frightened. The demons mocked and scorned me and sounded menacing. Even though the voices told me to do things, I never did what they said. Sometimes the voices came from machines. A running vacuum cleaner called me filthy names. Laundry machines, air conditioners, cars, and motorcycles all taunted me. The flame on the gas stove also spoke. Sometimes I thought I heard footsteps of huge invisible men following me. When I read a book, the words became audible. And when I walked, my footsteps were words. As the wind blew, it whispered messages in my ears.

In the midst of all this disintegration of the world as I had known it, one summer evening when night was falling, crickets began to chirp in four-part harmony. The sound was melodious and wonderful. Another time, as I was taking a walk, I came upon some small trees filled with tiny wrens. All of them twittered, excitedly, in little birdie voices: “I love you, Marcia! I love you!” It was so pretty. Walking through a garden, I heard the bees buzzing as little voices. Once during a storm, the rain was falling in a heavy downpour, and the sound of it falling became a voice. It said, “Believe in Jesus Christ and you will be saved.”

This message within the rainfall and the call to faith it invoked have been important factors in my recovery. A dramatic improvement in my mental health has resulted from this message. In general, the psychiatric community has been reluctant to acknowledge anything of value in psychotic phenomena, but I know in an experiential way that meaning can sometimes be found in them. I do not discount the validity of the medical model of psychiatric disorders. I am only saying that, in conjunction with the biochemical disarray of schizophrenia, there can be something else—something discernible amidst the chaos.

These psychotic phenomena lasted for more than a year, although I never lost complete contact with reality for more than a few minutes at a time. Finally, I realized that I needed a psychiatrist. I was not hospitalized at first, but was treated as an outpatient. Then, within a few weeks I was admitted to a hospital, and there the voices vanished. Since this first hospitalization in 1976, there have been only soft noises, not clear voices, and only intermittently.

I have schizophrenia, but this diagnosis covers a broad range of symptoms and many kinds of illness. I have not been paranoid. Beginning at age 22, I had one psychotic episode that lasted about 18 months—until I sought treatment. I have never again heard a clear voice; the soft noises occur only infrequently and do not annoy or distract me. A few successive hospitalizations have been because of depression. I’ve needed antidepressants off and on for many years. I’ve also had many negative symptoms that make it extremely hard to motivate myself or perform any task or job. It has been hard to become interested in anything. Quite often, it has been very difficult to determine whether I am depressed or apathetic, a negative symptom. Whether labeled as negative symptoms or as depression, this lack of interest and motivation has been a major problem for me.

One symptom of schizophrenia is disorganization. It is true that, even though I consider myself methodical in nature, my life had been very chaotic up until 1994. I went through 20 paid jobs and 6 volunteer positions. The longest I was able to stay with a paid job was 18 months, and it was only part-time. As a volunteer, my most successful venture was working at a domestic violence shelter, which lasted off and on for 4 years. My scholarly achievements extended to finishing a year in college and being asked to participate in an honors program. Along with my unstable employment record and short college career, I have been in various relationships, some of which were disastrous.

Many people with schizophrenia have thought disturbances. I do not have this problem. Quite the contrary, a few people have commented that I sound quite rational and do not appear to be ill.

In his book about mental illness, John Weir Perry (1974) says that he takes a holistic view of the human being—that the psychic and somatic processes are “indissolubly interwoven.” He believes the best therapy for psychosis considers both the psychic turmoil and the biochemical reflections of it. Doctors may think psychoses are the result of physiological disorder, because science and religion have long been considered immiscible. So, if someone in the field of psychology or psychiatry does not believe in God or spirituality, his or her interpretation of what happens to a person may leave out the possibility that God played a part in or through that person’s psychotic experience.

What may be derived from hallucinations? Can they have any meaning? Atheist psychiatrists may not think so and discount such ideas. When a therapist interprets thoughts, feelings, and behavior of his or her client using drug and psychological therapies, he or she may neglect a significant part of the psyche. Perhaps God can work through psychotic phenomena, and perhaps the psychosis of schizophrenia may bring about a fundamental reorganization of the self. The purpose of it may have been to transform my life—for indeed it has.

Scientific drug therapy and a life of faith have worked together in my recovery. The drug risperidone is the first antipsychotic that has alleviated my negative symptoms, although nothing has eliminated the soft noises I hear intermittently. Also risperidone may be giving me more emotional stability. Finding the correct dosage has been difficult, and doctors need to be very careful not to overprescribe. Along with taking this medication I have sought help from my religion. I attend church services and a Bible study class. It is the combination of risperidone and religious practice that gives me clear thinking.

Another improvement is that the extreme impulsiveness of my past has lessened a great deal. A big part of the original cause of that behavior was my own defiant attitude. Having been abused by authority figures in the past, I became disillusioned by people in authority. Therefore, I did not respect such persons or feel a need to obey rules. By turning back to religion, my impulsivity has diminished. I found orderliness in my thinking and respect for authority. The chaos of my schizophrenic behavior is nearly gone for I find I like to obey rules and feel the “anything goes” philosophy I once had is self-destructive.

Once in a while I still have setbacks, but in general, I’m doing much better. I have a lot more motivation and not so many negative symptoms or depression. When I relied only upon medication my condition was still poor. Drugs could only do so much, and something was lacking.

For example, I now see that much of my depression was a nihilistic crisis. According to the dictionary, nihilism is a general rejection of customary beliefs in morality, religion, and the like. It is the belief that there is no meaning or purpose in existence. This kind of crisis affects many in our materialistic Western culture. I denied the existence of any knowledge or truth. This is something that still creeps into my life almost daily. The problem of not finding meaning made me feel like a boat without a rudder and a ship without a captain. After all, if there is no purpose, why get up in the morning? And if there is no absolute basis for knowledge, why believe anything at all? This was quite depressing! My current belief system has aided me with these problems, and I no longer need medication for depression.

Another significant factor in my improvement has been the type of medical treatment and guidance I have received. I am fortunate to have had, for the past 20 years, a psychiatrist who favors a holistic approach to mental illness. I am grateful for the compassionate care I have received. My doctor treats me as more than a biological machine. Much of my good health stems from the fact I have been given support while searching for answers to the complex problem of schizophrenia.

Regardless of whether a therapist is atheistic, agnostic, or theistic, it is helpful when treating a person with schizophrenia to respect his or her belief system. Quite often an ill person may intuitively move in the right direction toward recovery. When doctors consider the belief system of a person, they may gain insight into directions to take in psychotherapy and medication adjustment.

If you don’t believe there can be meaning in an illness, my story is one that should challenge your thinking. My condition has improved dramatically not only because of finding the right medication but also because of a change in my belief system prompted by the content of hallucinations. The way I view the illness and the world incorporates both science and religion. I find them quite compatible.